Claremont Veterinary Hospital

New Client Form

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Claremont Veterinary Hospital New Client Form

Please fill out the form below as accurately as possible!

Name *

First

Last

Primary Phone *

Secondary Phone

Email *

Layout

Date of Birth *

Are you a senior citizen (65+) *

Spouse's Name

First

Last

Spouse's Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare?

Name of authorized person *

First

Last

Phone of authorized person:

Name of authorized person:

First

Last

Phone of authorized person:

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet Information

Pet's Name *

Species

Breed *

Color *

Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Date of last vaccinations:

Where were the vaccinations done?

Is your pet currently on any medication?

Does your pet have any allergies to vaccnations/ medications?

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, American Express and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

New Client Form

Claremont Veterinary Hospital New Client Form

Pet Information

Book an Appointment

Have A Question?

Location

Contact Information

Hours